The Coronavirus Pandemic and Disproportionate Death Rates for African Americans
Rodney G. Hood, MD, FACP
President and Founder, Multicultural Health Foundation
Past President, National Medical Association
Published San Diego Union Op-Ed April 15, 2020
People who believe they have COVID-19, and who meet the criteria, wait in line to be pre-screened for the coronavirus outside of the Brooklyn Hospital Center on March 20, 2020 in the Brooklyn borough of New York. (AFP via Getty Images)
In the early stages of this pandemic it appears that the African American communities are the hardest hit with disparate death rates compared to all other ethnic communities. Why? I can assure you that the coronavirus does not discriminate based upon skin color or ethnicity but has a predilection for the populations with the highest rates of chronic diseases, poor access to health services and lack of information from a trusted source.
For decades the National Medical Association (NMA) representing over 40,000 black physicians in US has been sounding the alarm that blacks are vulnerable to any disruption in the US health system. Compared to all other ethnicities, African Americans have higher rates of cardiovascular disease, hypertension, diabetes, asthma, obesity, and racialized poverty combined with poor access to health care which places this population at greater risk of morbidity during a major environmental catastrophe such as was seen with Hurricane Katrina with disproportionate deaths of black citizens. We should not be surprised with this deadly Covid19 pandemic that we are seeing the same outcome – blacks suffer disproportionate higher death rates. In Chicago blacks compose 30% of the population but account for 72% Covid19 deaths, Milwaukee has a 27% black population but 81% of Covid19 deaths, and Louisiana/New Orleans with 32% black population and 70% Covid19 deaths.
We see similar racial disparities in Michigan, Georgia, and New York with disparate Covid19 deaths for blacks, Hispanics and immigrants. Blacks represent 13% of US population but according to a CDC study, characteristics of patients hospitalized in 14 States with Covid19 showed whites = 45%, blacks = 33.1%, Hispanic = 8.1%, Asian =5.5%, and AI/AN = 0.3%.
These health disparities are caused by decades of ethnohistoric inequities within the healthcare and social support systems. Blacks experience multiple social barriers including racialized poverty, historic mistrust of the health system, and yes, life threatening overt and covert structural racism. So, when the social distancing was ordered blacks and other vulnerable populations found it difficult to implement. Many lost their jobs with no income and no health insurance finding themselves for the first time in food lines. Others who continued to work were considered priority frontline health care, safety, and service industry workers placing them at increased exposure to the coronavirus with inadequate information on how to protect themselves and their families. The historic mistrust of the health system within the African American communities caused many to consider unfounded myths and untruths as fact leading many to not take social distancing seriously.
In order to reverse health disparities, we must address the root causes and implement strategies that incorporate the equity principle. The equity principle is the distribution of resources based upon need rather than equal distributions. To achieve equity, we must distribute our limited health resources focused on the populations with the greatest health disparate needs. I believe we can attain this goal with national and local Covid19 intervention teams led by trusted community messengers who advise and educate about specific intervention strategies for vulnerable communities.
According to many scientists, it is predicted the nouveau coronavirus will be with us for the next 12 to 24 months. If correct, this virus will go through several outbreak cycles.
Currently, we have no vaccine, no effective treatment, and no herd immunity, therefore, unless equitable mitigation and containment strategies are planned with future outbreaks, we will see the same devastating results for blacks and other vulnerable communities. We must continue some form of social distancing until a vaccine or other effective treatment becomes available. Our strategy moving forward should include continued mitigation plus a public health “equity” approach that includes:
Testing and Tracing: To obtain data and develop an equitable long-term strategy, we need extensive free testing and contact tracing with a focus on the most vulnerable and high-risk populations including, African Americans, Hispanics and immigrants.
Treatment: When available, we need to ensure access and free coverage for vaccines and treatments with a priority on the identified vulnerable populations.
Trusted Messenger: To overcome the historic justified mistrust of Blacks and the US health system, we should engage institutions and individuals that are trusted by this community to deliver needed information on how to survive this and future pandemics.
Health Equity Intervention: If we are to resolve the issue of health inequities, we need to address pre-existing conditions. For Blacks, pre-existing conditions include structural racism and racialized poverty that have plagued America since slavery. An equitable solution should focus on disrupting these health and social injustices as we prepare for the next environmental catastrophe so a common saying in the Black community, “When white folks catch a cold, black folks catch pneumonia,” will never again become a reality.